Visual Stress During This COVID Mess

by Dr. Kimberly Douglas // October - November - December 2020

If there is one thing the pandemic has taught us, it is that even in our best attempts to be accommodating and flexible to our “new normal,” stressors have a way of making their presence known. Whether it is the occasional eye twitch, blurred vision, headaches, or dry eyes, stress can manifest itself right within our eye. Here is what to expect and tips on how to manage it all.

Stress can be characterized as any change that disrupts the body’s normal mental, physical, or emotional balance. If you consider the compounding of prolonged quarantines, remote learning obligations for students, changing social climate, everyday risk of contagion, along with regular stressors as the holidays approach, it is no wonder that your eye may experience an involuntary twitch or two.

The ocular effects related to stress can be numerous. They range from mild visual discomfort to severe vision loss. During the pandemic, increased use of digital devices, longer working hours, and fatigue from the demands of everchanging circumstances may induce increased eye stress.

Computer Vision Syndrome

Contrary to popular belief, computer vision syndrome is a real problem. It is caused by increased visual eye strain and fatigue due to extended periods of time on electronic devices such as computers, e-readers, tablets, and video gaming devices. The symptoms can be both musculoskeletal from improper posture to visual changes including blurred vision, double vision, eye dryness, redness, and irritation. Digital eye strain can also cause eye soreness, fatigue, and even trigger headaches. Treatment of this issue includes ergonomic adjustments to your workspace, anti-glare, blue blocking filters, proper lighting, increasing font size, taking frequent breaks, glasses correction, and lubricating drops.

Blurred Vision

As the adrenaline increases within our body during stressful events, it causes the pupil to dilate, allowing more light in, which causes increased light sensitivity and more blurred vision. This can also trigger headaches or migraines that can lead to episodes of blurred vision or blurred spots in vision.

A less common occurrence is hysterical vision loss, a type of vision impairment without a known structural or pathological cause. This is otherwise known as “conversion disorder.” The suppressed physical emotions (i.e. fear or anger) are manifesting as a true reduction in vision. We often see this in younger individuals who are undergoing stressful home or environmental changes.

Certain periods of high stress can also cause a condition called “Central Serous Chorioretinopathy.” Increased cortisol in the body can create fluid build-up in the portion of the back of the eye responsible for your central vision, called the macula. Mild cases can be treated with stress management and observation, but more severe cases are managed by a retinal specialist. Please see your eye care provider immediately with any sudden onset of blurred vision. It is important to determine the cause and find appropriate treatment.

Ocular Migraines

Migraine headaches are a common neurovascular disorder associated with stress or a release of stress. Visual auras frequently precede or accompany these headaches. People experience a variety of symptoms such as flashes of light, areas of blurred or missing vision, tunnel vision, lights, and a kaleidoscope effect. Often these symptoms can occur with or without the actual headache. If you experience these, it is essential to have a comprehensive eye exam to monitor for more serious problems affecting the back of the eye.

Uncorrected refractive error or binocular vision problems can contribute to these symptoms as well. Some of the more serious problems that need to be ruled out include retinal and vascular disease, along with compressive brain lesions or tumors. It helps to keep a headache journal to monitor the triggers which sometimes can include food, alcoholic beverages, and caffeine. In addition to getting the correct glasses prescription, vision therapy, blue blockers, anti-glare filters, and tinted lenses can help minimize the frequency.


One of the most common complaints we hear is “my eyelid has been twitching for weeks.” This is called myokymia and is caused by the involuntary, continuous contraction of the orbicularis oculi muscle that surrounds the eye. This can be very persistent, often affecting one eye at a time and lasting anywhere from days to weeks. Episodes often occur during periods of high emotional stress and fatigue, physical exertion, increased caffeine, or lack of sleep. Typically, myokymia is benign and will resolve without treatment. Very rarely can it be more serious of a problem. While often quite an annoyance to the person experiencing this, it is rarely visible to other people.

Treatment often consists of patient education and reassurance. We discuss the importance of reducing stress, caffeine intake, smoking, and alcohol use. We also highlight the importance of an adequate amount of overnight sleep (approximately eight hours). Patients who are highly symptomatic may benefit from subcutaneous Botox injections to stop the muscle spasm.

How We Adjust

Adapting to our new normal has taught us a lot, but not without sacrifice. It is only natural that during a season of change and uncertainty comes stress. The body can manifest stress in a variety of ways, including vision and ocular changes. The good thing about this issue is that is can be easily resolved by reducing stress. So, get out and exercise, be sure to get a full eight hours of sleep, adopt a healthy diet, and consider breathing exercises and meditation.

A lot of these stress-related eye symptoms can be quite alarming at first when you are uncertain of the cause. If there is any question as to what may be causing a new visual symptom, reach out to your eye doctor right away. Understand that visual health is as much in the mind as it is in the eye. Take a deep breath, activate your creative subconscious, recall positive affirmations, and reprogram your brain to recognize challenges as opportunities and not defeat. Let your eye doctor take care of the rest.

Dr. Kimberly Douglas

Kimberly Douglas, OD, FAAO is an associate doctor with McPherson Family Eye Care.